直肠癌腹壁造瘘口并发症的防治:附299例报告  

Prevention and treatment of complications of abdominal stoma after surgery for rectal cancer:a report of 299 cases

作　　者：郑阳春[1] 刘宝善[1] 徐琳[1] 燕锦[1] 刘超[1] 杜凤梅[1] 吴艳丽[1] 

机构地区：[1]四川省肿瘤医院腹部外科,四川成都610041

出　　处：《中国普通外科杂志》2010年第4期346-349,共4页China Journal of General Surgery

基　　金：四川省卫生厅资助课题(070020)

摘　　要：目的探讨直肠癌腹壁造瘘口并发症的原因及防治措施。方法回顾性分析直肠癌腹壁造瘘手术299例患者临床资料,观察造瘘口并发症的情况。结果造瘘口并发症发生率33.1%(99/299),其中造瘘口周围皮炎91例(30.4%),造瘘口狭窄8例(2.7%),造瘘口梗阻3例(1.0%),造瘘口脱垂17例(5.7%),造瘘口坏死2例(0.6%);端式造瘘组219例,其造瘘口周围皮炎、造瘘口脱垂的发生率明显低于袢式造瘘组(80例)(P<0.01);在端式造瘘组中,经腹膜外途径造瘘者(213例)其造瘘口梗阻及造瘘口旁疝的发生率又较经腹膜内途径造瘘者(6例)为低。结论术中对造瘘相关因素的及时处理及造瘘术式的合理选择有助于减少造瘘口并发症的发生。Objective To investigate the causes of complications of abdominal stoma after surgery on patients with rectal cancer, and to explore the measures of prevention and treatment. Methods The clinical data of 299 patients with rectal cancer who underwent abdominal ostomy were reviewed retrospectively. Results The overall incidence of stoma-associated complications was 33. 1% （99/299）. Peri-stomal dermatitis occurred in 91 cases （30.4%） , 8 cases （2.7%） suffered from stomal stenosis, 3 cases （1.0%） had with stomal obstruction, 17 cases （ 5. 7% ） had stomal prolapase and 2 eases （ 0. 6% ） had stomal necrosis. The incidence of peri-stomal dermatitis and stomal prolapase was much higher in patients with loop stoma than those with end stoma. In patients with end stoma, the occurrences of stomal obstruction and para-stomal hernia were less observed in those with extraperitoneal colostomy than those with transperitoneal colostomy. Conclusions Timely management of stoma related factors and reasonable choice of ostomy method could effectively reduce the occurrence of stomal complications.

关 键 词：直肠肿瘤/外科学 造瘘口 手术后并发症/预防与控制 

分 类 号：R735.3[医药卫生—肿瘤]